The authors selected forty-seven from all studies published on this topic between January 1978 and April 2018. From the available data they conclude that most patients did not have a significant alteration in the level of estrogen when using 5α-reductase inhibitors or spironolactone. No consistent evidence of increased risk of female breast cancer while on spironolactone was reported in 3 studies including 49,298 patients; the risk of breast cancer with the use of 5α-reductase inhibitors has not been studied. Given that breast cancer patients suffering from sustained alopecia and hirsutism frequently seek dermatological advice, the review touches a very sensitive topic and indicates that spironolactone could be considered for further research on alopecia and hirsutism in breast cancer patients.

Based on encouraging experimental studies, a possible role for phosphodiesterase 4 (PDE4) as a therapeutic target in alopecia areata has been discussed, but case studies revealed conflicting data. In this randomized placebo-controlled pilot study, Mikhaylov et al. treated 20 alopecia areata patients (≥ 50% scalp involvement) with the PDE4 inhibitor apremilast, while 10 patients were treated with placebo. They could not identify clinical efficacy over the course of 24 weeks with only one individual in each group achieving 50% reduction in the severity of alopecia tool score. In fact, 8/20 of the treated patients had prematurely withdrawn from the trail due to lack of efficacy.

In this article, the authors describe trichoscopic abnormalities they found in 34 children with tinea capitis. They assign specific appearances, e.g. comma, corkscrew shape or V-shapes, to tinea subtypes. A set of clinical photographs and dermatoscopic pictures provide valuable guidance for trichologists. The article underlines the practical relevance of this very efficient and handy tool. It also illustrates the importance of not missing those contagious causes of alopecia, especially when inflammation is mild or absent.

Histopathological examination is still the gold standard for the diagnosis of cicatricial alopecias. One major focus is usually the type and distribution of the inflammatory infiltrate. In this retrospective evaluation of 501 histologically confirmed cases of alopecia, the authors assessed the presence of premature desquamation of the inner root sheath (PDIRS) as an additional differentiating feature. While typical inflammatory alopecias such as lichen planopilaris, alopecia areata, discoid lupus erythematosus or acne keloidalis nuchae were characterized by PDIRS in association with inflamed hair follicles, PDIRS in at least one non-inflamed hair follicle was found to be a relatively specific indicator for central centrifugal cicatricial alopecia.

Because the cell interactions required for hair neogenesis are complex, translation of stem cell therapy into the clinics remains a challenge. Herein, the authors apply 3D printing technology to create controllable self-aggregating spheroid formation of dermal papilla cells (DPCs) in a physiologically relevant extracellular matrix. Furthermore, they address questions related to loss of DPC hair inductivity at the molecular level. Their results support their previously established hypothesis on the role of Fli-1 and Lef-1 in the formation of the aggregate and the subsequent human skin construct. This type of studies significantly advances translational efforts in tissue engineering.

The genetic etiology in about 50% of all cases of hypotrichosis simplex (HS) remains unclear. In their work, the authors describe mutations in the lanosterol synthase (LSS) gene in three unrelated families. They demonstrate LSS expression in the hair follicles as well as the impact of the mutations on keratinocytes. Interestingly, they found differential spatial distribution of the wild type compared to the mutated protein within the cells. Overall, as outlined in their conclusions, the identification of LSS as a causal gene for autosomal-recessive HS highlights the importance of the cholesterol pathway in hair follicle biology and may facilitate novel therapeutic approaches for hair loss disorders in general.